HPV DNA test most effective for long-term cancer detection

Provider characteristics influence HPV testing
Provider characteristics influence HPV testing

HealthDay News -- A baseline negative human papillomavirus (HPV) DNA test provides greater reassurance against invasive cervical intraepithelial neoplasia grade 3 (CIN3) at 18-year follow-up than baseline normal Papanicolaou (Pap) testing (cumulative incidence rate, 0.90% vs. 1.27%), study results show.

Although, both baseline Pap and HPV tests predicted who would develop CIN3+ within the first two years, only HPV testing predicted who would develop CIN3 10 to 18 years later, Philip E. Castle, MD, PhD, from the American Society for Clinical Pathology in Washington, D.C., and colleagues reported in the Journal of Clinical Oncology.

To examine the long-term benefits of clinical HPV DNA testing for cervical precancer and cancer risk prediction, Castle and colleagues collected cervicovaginal lavages from 19,512 women attending a health maintenance program, and retrospectively tested the samples for HPV. The women underwent prospective follow-up with routine annual Pap testing for up to 18 years.

Women who tested positive for HPV 16 and HPV 18, but who had a normal Pap where at increased risk for CIN3 compared with women positive for other strains of HPV who had a normal Pap, the researchers found. Women with normal Pap who were positive for HPV16 or HPV18 had a risk similar to those with low-grade squamous intraepithelial Pap.

These results provide further support in favor of routine HPV DNA testing in women aged older than 30 years or older, the researchers suggested.

"An HPV test provides greater reassurance against CIN3 and cervical cancer than Pap testing and
thus might be used as the screen to rule out disease in healthy women, whereas Pap is useful as a secondary diagnostic test to identify HPV-positive women at immediate risk of CIN3," the researchers wrote.

In an accompanying editorial, Cornelia L. Trimble, of Johns Hopkins School of Medicine, called the study "important," noting that it "provides data to support risk-based screening that can be done by using tools that are already available as part of routine practice."

Strengths of the suggested HPV DNA test primary screening algorithm are that it does not require specially trained personnel and potentially provides a way to effectively triage the use of health care services, Trimble noted.

References

  1. Castle PE et al. J Clin Onc. 2012; doi:10.1200/JCO.2012.42.9787.
  2. Trimble CL. J Clin Onc. 2012; doi:10.1200/JCO.2011.38.8389.

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